Organizational Providers: Change of Ownership Reminder

Is your organization in the process of changing ownership? If so, it’s important that you tell us at least 30 days in advance via the Change Of Ownership (CHOW) Form.

Timely notification is crucial for maintaining accurate provider files, ensuring seamless member access to care, and preventing potential disruptions to your participation in Highmark networks.

Your Highmark participation agreement outlines specific changes that require at least 30 days’ advance notice to Highmark. Failure to adhere to these notification requirements constitutes a potential breach of contract. These changes include, but are not limited to:

• Material changes — Mergers, consolidations, significant asset sales/purchases, changes in ownership interests or control, or management/affiliation agreements impacting covered services
• Changes affecting members' access to existing services
• Addition of new locations or services, including those through joint ventures or affiliations
• Updates to address, phone, and email information

Change of Ownership Notification – How the Process Works

After an organization submits the Change Of Ownership Form, Highmark will review the change notification to determine if an assignment of the participation agreement is required.

If Highmark consents to the assignment of the agreement, we will issue either a Consent to Assignment Agreement (CA) or a Contingent Consent to Assignment Agreement (CCA) to the provider.

There is a strict 45-day timeframe for the CA or CCA to be signed by both the old and new owners/operators. This 45-day period begins the day you receive the applicable CA or CCA. During this period, new Highmark members should not be accepted (until the contractual process is completed) to eliminate claims processing issues.

Failure to comply with this 45-day timeframe may result in severe consequences:

• The old owner/operator's provider profile will be terminated and will be considered Out of Network.
• The new owner/operator will be required to submit a Special Consideration Questionnaire. Be aware that Highmark's post-acute provider networks are currently closed. Applicants through the Special Consideration Questionnaire are rarely granted access unless Highmark has determined a significant market need.

Action Required

We urge all providers to review their contractual agreements and internal processes to ensure full compliance with these critical notification requirements. By providing timely and accurate information, you help us maintain a robust network for our members and ensure the continuity of your participation.